Search

Abstract Background NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England. Methods We used a modified version of Price’s (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 – March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change. Results Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts. Conclusion This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation. Study registration researchregistry6303.

Background Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. Aim To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Design Mixed-methods evaluation. Setting Four Resilience Hubs. Methods Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Results Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Limitations Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Conclusions Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information. Plain language summary Many health and social care staff struggled with mental health difficulties during the coronavirus disease 2019 pandemic. The study evaluated new National Health Service services (‘Resilience Hubs’) that were set up to help these keyworkers. We worked with four Hubs to: (1) look at who accessed the Hubs and what difficulties they had; (2) ask Hub ‘clients’ which support they used, and how helpful they found the Hubs; (3) look at what resources are needed to run the Hubs, to understand their ‘value for money’; (4) interview people who worked with or used the Hubs (e.g. Hub staff, Hub clients, but also keyworkers who did not use the Hubs) to have their feedback. We used this information to make recommendations for the Hubs and the organisations that work with them. We found that Hub clients were mainly National Health Service staff. Many had several mental health difficulties, including anxiety, depression and post-traumatic stress disorder. Few men, staff from minority ethnic communities, care home workers and emergency service staff used the Hubs. People were generally happy with the support they had from the Hubs; clients who completed a follow-up questionnaire rated the helpfulness of support provided by Hubs as 92 out of 100 on average. Staffing was the main cost, as Hubs were mainly staffed by experienced clinicians. Things that made it easier for people to use the Hubs were clear understandings of Hub support and how to access it, and the support of their managers/employers. Some keyworkers from minority ethnic communities wanted greater diversity in the Hub teams. Some had concerns around waiting times and about not knowing enough about how well these services worked. Feedback was otherwise very positive. Our recommendations included how to: better promote the Hubs; improve inclusion of and support for individuals from minority groups; get better data on how well and for whom they work; and for employers to pay more attention to the mental health and well-being of keyworkers beyond the coronavirus disease 2019 pandemic. Scientific summary Background The Resilience Hub model was developed in Greater Manchester to provide large-scale mental health screening and facilitate access to evidence-based mental health support for those affected by the 2017 Manchester Arena bombing. In response to the coronavirus disease 2019 (COVID-19) pandemic, the approach was adapted to provide mental health screening and facilitation of access to psychosocial support for NHS, social care and emergency response keyworkers affected by the pandemic. Since 2020, the model has been replicated in 40 UK regions. Objectives While over time the offers of the Hubs expanded to include further team-based support (e.g. well-being workshops for teams), the overarching aim of this mixed-method project was to evaluate and provide key recommendations in relation to two central functions of the individual support of the Resilience Hubs that were either already operational or at an advanced stage of set-up in the early phases of the pandemic that is the provision of mental health screening to in-scope keyworkers from NHS, social care, and emergency response services; and the facilitation of access to psychosocial support. Data were collected from four Resilience Hubs in the North of England to address the following objectives: Objective 1: To conduct a quantitative analysis of routine demographic, occupational and mental health screening data, to provide findings to model service demand and guide future adaptations to the Hub approach to suit contextual needs and inform evidence-based commissioning. Objective 2: To conduct a health economic analysis to explore the cost and health benefits associated with the set-up, use and management of Resilience Hubs. Objective 3: To conduct qualitative interviews with multiple stakeholder groups to identify the barriers and enablers to the implementation/scaling of the Hub model. Objective 4: To produce mixed-method case studies, integrating findings from the above qualitative and quantitative components and produce key recommendations. Methods To address Objective 1, we analysed data from routine mental health screening data collected by the Hubs on a combined sample of 1973 Hub clients, and service use data from a subsample of 299 Hub clients who completed a follow-up survey deployed 5–8 months after the completion of the Hub screening. Statistical analyses were conducted to examine the demographic and occupational characteristics of Hub clients, the incidence of clinically significant mental health difficulties in the sample, potential predictors of higher mental health needs, and summarise the level of mental health service access and overall satisfaction following Hub support and advice. To address Objective 2, we (1) analysed costing data provided by the Hub teams to estimate the set-up and ongoing cost of Hub service delivery per keyworker supported; (2) costed health and social care service use data obtained from the abovementioned follow-up survey using nationally published unit costs; (3) calculated EQ-5D values for participants in the follow-up survey using the crosswalk algorithm recommended by the National Institute for Health and Care Excellence at the time of data collection, which were then compared to published population norms and to a pre-pandemic sample of keyworkers. A logic model was also developed to illustrate the potential benefits associated with Hub support. To address Objective 3, we conducted 63 qualitative interviews with key stakeholder groups at three Hubs, including Hub staff (n = 14), Hub clients (n = 19), keyworkers eligible for Hub support but who had not accessed these services (n = 20), wider stakeholders who had involvement in the provision of staff support within the health and care system (e.g. occupational health leads; HR leads; n = 10). Efforts were made to interview keyworkers from under-represented groups (e.g. keyworkers from ethnic minority communities). Topic guides and data analysis were informed by well-established analytic frameworks (normalisation process theory and Sekhon’s Acceptability Framework) to explore the barriers and enablers to implementation of the Resilience Hub model. To address Objective 4, key findings from Objectives 1–3 were integrated via mixed-methods case studies. Hub-level cross-case analyses were used to integrate data at a site level, and subgroup-level cross-case analyses were used to explore low uptake by certain demographic and occupational groups. Data were triangulated across work packages to demonstrate how they supported conclusions. Results Most keyworkers who completed the screening offer of the Hubs were NHS employees (44–87%), identified as women (83–86%), and from a White British background (89–92%). Considerably smaller proportions identified as men (13–16%), members of minority ethnic groups (5–7%), social care staff (4–8%). Likewise, emergency services staff were a smaller group accessing the Hubs (1–12%), although not all emergency services were in scope at all Hubs. Most keyworkers had considerable and often co-occurring mental health needs across all domains assessed (anxiety as assessed by the generalised anxiety disorder 7-item questionnaire; depression, patient health questionnaire 9-item questionnaire; post-traumatic stress, post-traumatic stress disorder checklist for DSM-5 or ITQ; problematic alcohol use, alcohol use disorders identification test; and impaired functioning as assessed by the work and social adjustment scale), with 60% meeting criteria for clinically significant difficulties on at least three different screening measures. Approximately 80% of Hub clients reported clinically significant impairments in functioning. Only 10% of clients had subclinical scores across all measures. Regression analyses to identify candidate predictors of higher mental health need in this sample found that several demographic characteristics (e.g. having a disability; identifying as any sexual orientation excluding heterosexual) were associated with higher likelihood for clinically significant mental health concerns. Several work-related circumstances during the pandemic were associated with higher need on specific mental health domains, including working in intensive care units or emergency care environments, moving to new work locations and undertaking new tasks during the pandemic. Experiencing stressful life circumstances brought about by the pandemic (e.g. being ill or hospitalised with COVID, bereavements during the pandemic) was similarly associated with higher need. The two most consistent predictors of higher need were suffering a household financial loss during the pandemic and having a history of mental health/emotional well-being concerns prior to the pandemic. Service use data for the 299 Hub clients who completed the follow-up survey indicated that most respondents (73%) had some form of contact with Hub staff following screening. Fifty-seven per cent reported receiving some form of mental health support since screening, and 11% were on a waiting list for mental health support. Approximately 75% of respondents accessed support that was provided directly by Hub staff or other services that were first accessed as a result of Hub support and advice. Participants reported high levels of satisfaction with the support they received from the Hubs. The median rating of perceived helpfulness of the support provided by the Hubs was 92 (on a 0–100 scale). A large proportion of participants (46%) reported that the Hubs fully met their needs, with only a small minority reporting that the support provided did not meet their needs (4%). Approximately a third of participants reported they did not require support from services other than the Hubs, either because they received all the support they needed from their local Hub or because no further mental health support was required from the Hubs or other services. A further 28% reported that the Hubs helped them to access other beneficial services. Only 5% of participants reported they did not receive help to access the support they believed they needed. The results of the health economic analyses indicated that set-up and ongoing annual costs were variable across Hubs, depending on design. Staff costs accounted for the majority of ongoing costs. Analysis of service use data demonstrated that mental health support was the greatest contributor to total NHS and social care cost, with a mean cost of £376 [95% confidence interval (CI) £294 to £459] versus a mean cost of £138 (95% CI £73 to £202) for wider health and social care use. Services delivered or accessed as a result of Hub support made up over half of the total health and social care service costs. This demonstrates an important component of service costs resulting from Hub support, in a group with minimal contact from other services. Mental health care costs were associated with the Hub accessed and concerns about mental health prior to the pandemic. Hub clients’ mean EQ-5D value was 0.755 (95% CI 0.731 to 0.779), indicating a lower health status compared with population norms and a pre-pandemic sample of health and social care workers. Being from an ethnic minority group was found to be associated with lower health status, as was having higher need at screening, a disability, a bereavement or having had a COVID-related hospitalisation. An economic evaluation was determined not to be possible with the current evidence base and subsequently conclusions around cost-effectiveness could not be made. Work to inform the logic model to guide future evaluations identified a number of potential benefits associated with Hub support, including improved mental health and well-being, reduced risk of burnout and potential economic benefits not only keyworkers but wider groups (services, colleagues, family members, patients). Qualitative data indicated that Hub staff clearly perceived Hub support as distinct from other forms of staff support, but described some challenges in helping the health and care system to understand the value of Hub support. Wider stakeholders tended to see Hubs as a resource for people with more complex or severe difficulties, a finding that resonates with the quantitative findings above. Keyworkers were more likely to access Hub support when they understood it, differentiated it from other types of support, and felt supported by managers to access it. However, some keyworkers felt overwhelmed by different support offers during the pandemic, creating confusion about how the Hubs could support them. Some keyworkers had wider concerns around accessing mental health support (e.g. beliefs about needing to be strong due to their job role; not wanting to take up a resource from which others may have benefitted more). Other barriers included perceptions that employers did not genuinely support help-seeking, negative workplace culture and wider systemic issues that were perceived as the cause of distress. Some keyworkers who specifically wanted support around the impact of racism and discrimination felt that diverse staff representation within Hub clinical was lacking, which was also acknowledged by some Hub staff. Other barriers for these groups included previous negative experiences of health and social care services, structural inequalities and community stigma. Wider stakeholders shared some concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes being presented back to the system. With the exception of the above concerns, appraisal of the Hubs was very positive. The responsiveness of the Hubs to local needs was strongly valued by all groups interviewed. Participants felt that the Hubs should continue to evolve according to local and national needs, including the continuation of staff support, and response to traumatic incidents. Hub-level integration of data revealed that findings were consistent across the Hubs, despite differences in model implementation. The finding that most keyworkers accessing the Hubs had clinically significant mental health difficulties is potentially explained by the fact that wider stakeholders viewed the Hubs as resource for keyworkers with more severe or complex mental health difficulties, and that keyworkers typically waited until things were very difficult before seeking support. The demographic and occupational groups accessing services were broadly consistent. Low uptake from keyworkers from minority ethnic groups may be explained by interview findings, whereby some participants described wanting Hub teams to have greater diversity, cultural competency training and experience in supporting people with the impact of racism. Service use data demonstrated that some keyworkers from these communities accessed alternative sources of support, such as faith organisations. Data from other under-represented groups were limited, however stigma was identified frequently as a barrier for keyworkers identifying as men. Wider stakeholders suggested that low uptake of care home staff may have been a consequence of less formalised routes of occupational support, leading to a different culture of help-seeking, which could add to other practical barriers that may not have been experienced within the NHS (e.g. less flexibility of shifts to attend appointments). Interview findings suggested that shift work may also have affected low uptake from emergency services staff. Other barriers for emergency staff included beliefs around job role, such as keyworkers feeling that they should be able to handle stressful or traumatic experiences as a routine part of their job. Keyworkers also described wanting support from someone who understood their job, and so reported often seeking support through work. Conclusions The research demonstrates a need for ongoing mental health and well-being support for health and care staff beyond the pandemic, and highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support. The model has been shown to be sufficiently adaptable to different contexts (e.g. a new target population; different regional settings), and as a potential system to be repurposed for future response to other large-scale crises. Key recommendations for the Hubs include the continued provision of outreach, mental health screening and direct and indirect support to keyworkers; implementation of suggested strategies to maximise Hub promotion; actions to address equality, diversity and inclusion access issues and guide the strategic allocation of the Hubs’ specialist resources and team-based support; and information flow between Hubs and partner organisations. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual and reactive support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges that might underpin or exacerbate the well-being difficulties of the health and social care workforce. Recommendations for future research and evaluation of the Hub approach include larger-scale national service mapping exercises of Hub services (to better understand differentiation in how Hub offers and key functions are operationalised across the country), the standardisation and generation of routine screening and outcome data across Hubs for evaluation purposes, and more robust clinical and cost-effectiveness evaluations of the Resilience Hubs using comparative data in the context of natural experiment studies. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.

Abstract Background There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools such as smartphones have the potential to increase access to mental health support and may provide an opportunity for YP to both manage their distress and reduce the possibility of further victimization. The current study explores the acceptability of a digital health intervention (DHI; the i-Minds app) which is a theory-driven, co-produced, mentalization-based DHI designed for YP aged 12–18 who have experienced TASA. Methods Semi-structured interviews were conducted with 15 YP recruited through Child and Adolescent Mental Health Services, a Sexual Assault Referral Centre and an e-therapy provider who had access to the i-Minds app as part of a feasibility clinical trial. Interviews focused on the acceptability and usability of i-Minds and were coded to themes based on the Acceptability of Healthcare Interventions framework. Results All participants found the i-Minds app acceptable. Many aspects of the app were seen as enjoyable and useful in helping YP understand their abuse, manage feelings, and change behavior. The app was seen as usable and easy to navigate, but for some participants the level of text was problematic and aspects of the content was, at times, emotionally distressing at times. Conclusions The i-Minds app is useful in the management of TASA and helping change some risk-related vulnerabilities. The app was designed, developed and evaluated with YP who had experienced TASA and this may account for the high levels of acceptability seen. Trial registration The trial was registered on the ISRCTN registry on the 12/04/2022 as i-Minds: a digital intervention for young people exposed to online sexual abuse (ISRCTN43130832).

Abstract Microbial diversity of caves is largely understudied and its possible applications are still unknown. Autochthonous fungi, in particular, may have the potential to biomineralize metals and may be used as promising agents for bioremediation of polluted sites; thus, unearthing the fungal diversity in hypogean ecosystems is nowadays of utmost importance. To start addressing this knowledge gap, the cultivable mycobiota of two neighbouring caves—one natural and one exploited for touristic purposes—were characterised and compared by studying fungi isolated from sediments collected at increasing distances from the entrance. Overall, 250 fungal isolates ascribable to 69 taxa (mainly Ascomycota) were found, a high percentage of which was reported in caves for the first time. The sediments of the touristic cave displayed a richer and more diversified community in comparison with the natural one, possibly due to visitors carrying propagules or organic material. Considering that these environments are still poorly explored, chances to detect new fungal lineages are not negligible.

BackgroundFace-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. ObjectiveThis study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. MethodsSemistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. ResultsThe findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. ConclusionsThis study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants’ environments to gain deeper insight into their subjective worlds.

Abstract Emerging fungal pathogens are a global challenge for humankind. Many efforts have been made to understand the mechanisms underlying pathogenicity in bacteria, and OMICs techniques are largely responsible for those advancements. By contrast, our limited understanding of opportunism and antifungal resistance is preventing us from identifying, limiting and interpreting the emergence of fungal pathogens. The genus Scedosporium (Microascaceae) includes fungi with high tolerance to environmental pollution, whilst some species can be considered major human pathogens, such as Scedosporium apiospermum and Scedosporium boydii. However, unlike other fungal pathogens, little is known about the genome evolution of these organisms. We sequenced two novel genomes of Scedosporium aurantiacum and Scedosporium minutisporum isolated from extreme, strongly anthropized environments. We compared all the available Scedosporium and Microascaceae genomes, that we systematically annotated and characterized ex novo in most cases. The genomes in this family were integrated in a Phylum-level comparison to infer the presence of putative, shared genomic traits in filamentous ascomycetes with pathogenic potential. The analysis included the genomes of 100 environmental and clinical fungi, revealing poor evolutionary convergence of putative pathogenicity traits. By contrast, several features in Microascaceae and Scedosporium were detected that might have a dual role in responding to environmental challenges and allowing colonization of the human body, including chitin, melanin and other cell wall related genes, proteases, glutaredoxins and magnesium transporters. We found these gene families to be impacted by expansions, orthologous transposon insertions, and point mutations. With RNA-seq, we demonstrated that most of these anciently impacted genomic features responded to the stress imposed by an antifungal compound (voriconazole) in the two environmental strains S. aurantiacum MUT6114 and S. minutisporum MUT6113. Therefore, the present genomics and transcriptomics investigation stands on the edge between stress resistance and pathogenic potential, to elucidate whether fungi were pre-adapted to infect humans. We highlight the strengths and limitations of genomics applied to opportunistic human pathogens, the multifactoriality of pathogenicity and resistance to drugs, and suggest a scenario where pressures other than anthropic contributed to forge filamentous human pathogens.

Cybercrime is a major challenge facing the world, with estimated costs ranging from the hundreds of millions to the trillions. Despite the threat it poses, cybercrime is somewhat an invisible phenomenon. In carrying out their virtual attacks, offenders often mask their physical locations by hiding behind online nicknames and technical protections. This means technical data are not well suited to establishing the true location of offenders and scholarly knowledge of cybercrime geography is limited. This paper proposes a solution: an expert survey. From March to October 2021 we invited leading experts in cybercrime intelligence/investigations from across the world to participate in an anonymized online survey on the geographical location of cybercrime offenders. The survey asked participants to consider five major categories of cybercrime, nominate the countries that they consider to be the most significant sources of each of these types of cybercrimes, and then rank each nominated country according to the impact, professionalism, and technical skill of its offenders. The outcome of the survey is the World Cybercrime Index, a global metric of cybercriminality organised around five types of cybercrime. The results indicate that a relatively small number of countries house the greatest cybercriminal threats. These findings partially remove the veil of anonymity around cybercriminal offenders, may aid law enforcement and policymakers in fighting this threat, and contribute to the study of cybercrime as a local phenomenon.

Abstract A Gamma Variant RBD-based aluminum hydroxide adjuvanted vaccine called ARVAC CG was selected for a first in human clinical trial. Healthy male and female participants (18-55 years old) with a complete COVID-19-primary vaccine scheme were assigned to receive two intramuscular doses of either a low-dose or a high-dose of ARVAC CG. The primary endpoint was safety. The secondary objective was humoral immunogenicity. Cellular immune responses were studied as an exploratory objective. The trial was prospectively registered in PRIISA.BA (Registration Code 6564) and ANMAT and retrospectively registered in ClinicalTrials.gov (NCT05656508). Samples from participants of a surveillance strategy implemented by the Ministry of Health of the Province of Buenos Aires that were boosted with BNT162b2 were also analyzed to compare with the booster effect of ARVAC CG. ARVAC CG exhibits a satisfactory safety profile, a robust and broad booster response of neutralizing antibodies against the Ancestral strain of SARS-CoV-2 and the Gamma, Delta, Omicron BA.1 and Omicron BA.5 variants of concern and a booster effect on T cell immunity in individuals previously immunized with different COVID-19 vaccine platforms.

IntroductionThere has been a rapid increase in prevalence rates of online sexual abuse (OSA). Existing research has highlighted the negative impact OSA can have on victims. However, there is a gap in understanding the long-term impact of OSA when it occurred in childhood.MethodsThis qualitative study comprised interviews with eight female participants aged 18–28 years recruited in UK NHS Trusts, and via mental health charities, University bulletins and social media. Each participant self-reported having experienced abuse through either the production or dissemination of sexual material online.ResultsResults showed that the longer-term impact of OSA was multi-fold, including negative impact on sense of self and broader interpersonal relationships, and significant impact on the participants’ mental health, including experiences of self-harm, anxiety, and low mood. Likewise, participants discussed long-term apprehension to taking images and the added fear and worry that their sexual images were distributed online. Seven participants had received mental health support but only two recounted a positive experience when receiving support for OSA.DiscussionFuture research using a quantitative longitudinal design is needed to further explore the prolonged impact of OSA. Clinical implications of the research highlight the need for support services to assess the impact of OSA and interventions that target OSA experiences.

Standard platinum-based chemotherapy is the basis of treatment of many cancers, however a proportion of patients do not derive benefit. Here the authors show that the platinum-based drug oxaliplatin accumulates in cancer-associated fibroblasts, activating pathways associated with cancer progression and resistance to therapy.

Abstract To date, the highly adapted cave microbial communities are challenged by the expanding anthropization of these subterranean habitats. Although recent advances in characterizing show-caves microbiome composition and functionality, the anthropic effect on promoting the establishment, or reducing the presence of specific microbial guilds has never been studied in detail. This work aims to investigate the whole microbiome (Fungi, Algae, Bacteria and Archaea) of four Italian show-caves, displaying different environmental and geo-morphological conditions and one recently discovered natural cave to highlight potential human-induced microbial traits alterations. Results indicate how show-caves share common microbial traits in contrast to the natural one; the first are characterized by microorganisms related to outdoor environment and/or capable of exploiting extra inputs of organic matter eventually supplied by tourist flows (i.e. Chaetomium and Phoma for fungi and Pseudomonas for bacteria). Yet, variation in microalgae assemblage composition was reported in show-caves, probably related to the effect of the artificial lighting. This study provides insights into the potential microbiome cave contamination by human-related bacteria (e.g. Lactobacillus and Staphylococcus) and commensal/opportunistic human associated fungi (e.g. Candida) and dermatophytes. This work is critical to untangle caves microbiome towards management and conservation of these fragile ecosystems.